Holley Dornfeld, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

19295-130 Issued in WI

Practice address

571 County Road a
Green Lake, WI 54941-8630

Phone

(920) 294-4070

Fax

(920) 294-4139

NPI assigned

Oct 27, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Green Lake

  • Public Health or Welfare Agency
  • Green Lake, WI
  • NPI 1588435382
  NPD
• County of Green Lake

  • Professional Counselor
  • Green Lake, WI
  • NPI 1780867408
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1669072872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418630",
            "telephone_number": "920-294-4070",
            "fax_number": "920-294-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418630",
            "telephone_number": "920-294-4070",
            "fax_number": "920-294-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORNFELD",
        "first_name": "HOLLEY",
        "credential": "SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19295-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Medical Center of Green Lake, LLC
• Community Options, Inc.
• County of Green Lake
• County of Green Lake
• Shirley J. Dawson, M.D.
• Melanie Amanda Ellis, PMHNP-BC
• Nancy Jean Gimenez, RN, BSN, MS
• Green Lake County Senior Transportation, Inc
• Green Lake Medical Clinic
• Green Lake Medical Clinic , S.C.

• Addiction (Substance Use Disorder) Counselor in Green Lake, WI
• Providers in Green Lake, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.